University Eye Hospital Freiburg, Germany.
Dtsch Arztebl Int. 2013 May;110(21):376-85; quiz 386. doi: 10.3238/arztebl.2013.0376. Epub 2013 May 24.
Giant cell arteritis (GCA) is the most common systemic vasculitis in persons aged 50 and above (incidence, 3.5 per 100,000 per year). It affects cranial arteries, the aorta, and arteries elsewhere in the body, e.g., in the limbs.
We selectively review the pertinent literature, including guidelines and recommendations from Germany and abroad.
The typical symptoms of new-onset GCA are bitemporal headaches, jaw claudiacation, scalp tenderness, visual disturbances, systemic symptoms such as fever and weight loss, and polymyalgia. The diagnostic assessment comprises laboratory testing (erythrocyte sedimentation rate, C-reactive protein), imaging studies (duplex sonography, high-resolution magnetic resonance imaging, positron-emission tomography), and temporal artery biopsy. The standard treatment is with corticosteroids (adverse effects: diabetes mellitus, osteoporosis, cataract, arterial hypertension). A meta-analysis of three randomized controlled trials led to a recommendation for treatment with methotrexate to lower the recurrence rate and spare steroids. Patients for whom methotrexate is contraindicated or who cannot tolerate the drug can be treated with azathioprine instead.
Giant cell arteritis, if untreated, progresses to involve the aorta and its collateral branches, leading to various complications. Late diagnosis and treatment can have serious consequences, including irreversible loss of visual function.
巨细胞动脉炎（GCA）是 50 岁及以上人群中最常见的系统性血管炎（发病率为每年每 10 万人 3.5 例）。它影响颅动脉、主动脉和身体其他部位的动脉，例如四肢的动脉。
我们选择性地回顾了相关文献，包括德国和国外的指南和建议。
新诊断的 GCA 的典型症状是双侧颞部头痛、下颌运动障碍、头皮触痛、视力障碍、全身症状如发热和体重减轻以及多发性肌痛。诊断评估包括实验室检查（红细胞沉降率、C 反应蛋白）、影像学检查（双功能超声、高分辨率磁共振成像、正电子发射断层扫描）和颞动脉活检。标准治疗是使用皮质类固醇（不良反应：糖尿病、骨质疏松症、白内障、动脉高血压）。三项随机对照试验的荟萃分析得出了使用甲氨蝶呤降低复发率和减少类固醇用量的建议。对于不适合使用甲氨蝶呤或不能耐受该药的患者，可以用硫唑嘌呤代替。
如果不治疗，巨细胞动脉炎会进展累及主动脉及其侧支分支，导致各种并发症。延迟诊断和治疗可能会产生严重后果，包括视力不可逆转的丧失。
